Since the Roosevelt administration (Teddy, that is), the US federal government has periodically engaged in the debate over how to make the health care system work better for the American people. Meanwhile, under the supervision of the “invisible hand” of the free market, the US health care system has led to 45,000 Americans dying every year simply because they do not have health insurance. Every time health care reform comes up in Congress, the monied interests in the health care system – hospitals, pharmaceutical companies, and health insurance companies – have succeeded in blocking reform. At the same time, we have watched as every other industrialized nation ensures that all of their citizens have access to quality, affordable health care. In the company of the industrialized world, the US alone still considers health care a privilege for the wealthy rather than a right for every citizen.
The US House of Representatives made history this month by being the first branch of congress to pass a comprehensive health reform bill. With last night’s release of the Senate’s combined Patient Protection and Affordable Care Act (pdf), America is one step closer to achieving the goal of quality, affordable health care for every citizen.
There are positive and negative features of the Senate bill as compared to the House bill. On the positive side, the House’s Stupak-Pitts amendment is not present in the Senate bill. Stupak-Pitts would make it illegal for any health insurance plan that takes part in the proposed health insurance exchanges to offer coverage for abortion. By leaving this language out, the Senate bill will hopefully maintain the status quo for access to what has been a legal medical procedure in America for 36 years.
As for the mixed news, the Senate bill still retains the public option with a state opt-out provision, in contrast to the House bill, which contains an opt-out-free public option. The public option is crucial for real reform because it can provide competition to private insurance companies, which often have near-monopolies in their markets. Both bills contain new regulations on insurance companies, but without competition from the public option, there would be nothing to stop the industry from passing the entire cost of new regulations onto consumers through even higher premiums and deductibles.
The problem with the opt-out provision is that, in order to reduce the price tag of the Senate bill to appease “fiscal conservatives,” almost none of the reform provisions, such as the public option, Medicaid expansion, and the insurance exchanges, will take effect until 2014. At the same time, state legislatures can opt out of the public option immediately, which many red states likely will, thus reducing the scope of the already-weakened public option and its ability to rein in the lethal excesses of the for-profit health insurance industry.
Amazingly, the fight for meaningful health reform still has a very long way to go. Will the Senate bill even be brought up for debate, let alone voted on? If the resulting bill is weak enough, will Senate Majority Leader Reid work through budget reconciliation, which only requires 50 votes instead of 60, to get legislation that may actually fix American health care? Only time will tell, but when another American dies every 12 minutes because they don’t have insurance, time is of the essence.
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